The effects of the 2012 Health and Social Care Act are now too disastrous to ignore. But Jeremy Hunt’s shift is of rhetoric, not of substance - .and his new “ACO” plans are so dangerous, campaigners this week challenged them in the High Court.

Image: Campaigners in front of the High Court this week as their Judicial Review opened. Credit: Daniel Lucas/Dpict Media

The leader of the Opposition’s opening gambit in PMQs this
week was to put Theresa May on the spot over how much of NHS services are currently being outsourced to the private sector. Rather predictably, she had
no answer of substance to this question.

Most people are aware by now that the NHS is at breaking
point. But what much of the public are still in the dark about is exactly how this crisis is happening or being
navigated.

Anyone wanting to find out would be well-advised to take a
look at incoming Accountable Care Organisations, which threaten to usher in an
‘Americanisation’ of services and possibly the largest vehicle for future
privatisation in the NHS’s history. This week, the High Court heard about the
impending introduction of these ACOs from a team of 4 senior health
professionals (previously
5, until the death of the late Professor Stephen Hawking in March). This
judicial review looks to ensure that a shake-up as large as this does not occur
without the proper public consultation and parliamentary scrutiny such a
significant restructuring of public healthcare should entail.

Along with legislative efforts to reinstate statutory
responsibility for the health of people across England – which was essentially
torn away by Andrew Lansley in 2012
- the case forms part of a several-year-long campaign to restore public
healthcare (as set out in the NHS’s founding charter) as well as to uncover
what transatlantic interests have
planned for it.

What are ACOs? And why are they such
cause for concern?

Already piloted quietly across 10 areas in
England, Accountable Care Organisations boil down to a large-scale
reorganisation and ‘integration’ of care providers. In theory, ACOs could be
owned by NHS hospitals or GPs. But there may be nothing in place to stop them
from being controlled by large insurance companies, finance and property firms
who could eventually take them over and run them purely for profit.

Through these new integrated care systems, the government
looks to pool health and social care budgets from NHS England, Clinical
Commissioning Groups (CCGs) and General Practice with local authority budgets
into contracts to be awarded on a per capita basis. This means that ACOs could
be a financial “Special Purpose Vehicle”, a public body or a private company.
The longer-term upshot may be that CCGs disappear altogether and ACOs take on
commissioning responsibilities, presenting them with the power to alter
resources and patient composition.

One central concern that has been raised relates to the way
ACOs appear to blur the lines between the definition of care that’s ‘free at
point of use’, care that’s charged at point of use and care that’s sold off
privately. This obviously goes straight to the heart of the NHS’s founding
principle of universal public healthcare provision. It is also a partial
carry-over from NHS England chief Simon Stevens’ nebulous promise
to “dissolve the classic divide[s]” of healthcare in his 2014 Five
Year Forward View, which at the same time pledged to reduce tens of
billions in expenditure before 2021.

During the last two years, some of the largest
ever contracts for NHS services have emerged. One of the first of these
super contracts was in Dudley, where financial details of the 15-year
Multispecialty Community Provider (MCP) agreement are not known. Then, in April
2017, a Manchester
commissioning group announced the largest ever tender for NHS services, in
a contract worth £6 billion, for a provider of all out-of-hospital care in an
area serving around 600,000 patients. Last year was also the advent of the first
“voluntary” contracts to be awarded to GPs and Trusts now operating as
tender-based, unofficially pro-profit businesses.

In February this year, a High Court judge temporarily blocked
Lancashire County Council’s attempt to outsource a £104 million childcare
contract to Virgin. This ruling came only weeks after NHS bodies were forced to
make an undisclosed
settlement to the health branch of Richard Branson’s conglomerate over its loss
of a £82 million contract to provide children’s health services across Surrey.

ACOs could open the door to a great deal more private US
equity firms looking to prise open the £120
billion oyster of UK healthcare. Fears of backdoor privatisation have been
compounded by indications from an increasingly embattled
May, who is desperately scrambling
to secure a future trade deal with the US post-Brexit.

Accountable Care?

Despite talk of unification, “seamless” integration and the
government’s persistent use of ‘local’ areas and populations in its language
around ACOs, they will almost certainly fragment, outsource and create an
increasingly complex commercial model of healthcare - instead of an open, transparent,
directly-accountable model of provision. ‘Accountable care’ couldn’t be any
more of a misnomer.

ACOs’ taxonomy of “local health systems”, each with their
own geographic “footprints”, was inherited from the division of local
healthcare in England under Sustainability
and Transformation Plans (STPs), Stevens’ last grand solution to plug a £22
billion annual funding gap before this latest move. A core problem with STPs
was its delegation
of responsibilities to these new ‘localities’, with no clear statutory
rules or external regulation governing the care provision process. This
question is one that has not become any clearer during the introduction of
ACOs, for all the government’s talk of openness and liability.

Jeremy Hunt’s visions
of a tech
panacea have also been part of the push towards ACOs, as well as to square
various circles left by Stevens’ glib tracts. Meanwhile, underfunding
of basic IT
facilities in hospitals has continued – as was made all too clear in last
year’s WannaCry
ransomware attacks.

Government officials maintain
that ACOs are not a move towards US-style privatisation, accusing campaigners
of generating “pernicious falsehoods” and “irresponsible” alarmism, while
insisting the plans “are simply about making care more joined-up between
different health and care organisations”. The pro-market King’s Fund has reiterated
this message, arguing that identifications with US healthcare are mistaken and
that the NHS needs more integrated care to survive.

But, as public health expert Allyson Pollock has
pointed out, commercial contracting and subcontracting in the NHS is already
happening on a scale and at a duration never considered by the 2012 Health and
Social Care Act. This was one of a number of crucial concerns which either
weren’t raised or were stamped out during the legislation’s passage through
parliament. It’s little surprise, then, that government and pro-market bodies
are trying to keep campaigners quiet about ACOs (as they did around the
time of Lansley’s reforms) especially given these bodies’ cosy ties with US
private health.

Although May deflected Corbyn’s outsourcing question at this
week’s PMQs, Allyson Pollock argues that only 36% of healthcare contracts were
won by NHS providers in the financial year 2016-17, compared to 60% in 2014-15.
And we also know private providers won £3.1 billion of new contracts in
2016-17, 43% of total advertised value.

If anything, ACOs form part of a discursive shift rather
than a shift from policy’s direction of travel after the effects of the disastrous
2012 Act became too obvious to ignore – and then needed to be ‘tidied up’. This
shift signalled a move away from talk of breaking up public healthcare
(remember, Lansley’s top-down
reforms were a “reorganisation so big you can see it from outer space”)
towards a language of “collaboration” into which the term “integration” fits
neatly.

The truth is there is no real or meaningful local
accountability with ACOs: no one knows what will happen if private contractors
walk away from their contracts, or if they choose to close services and sell
off buildings in search of more lucrative ventures, as has been happening
recently with nursing
home closures.

The JR4NHS case and NHS
re-instatement

Sometimes the conversation around the protection and the
future of the NHS can seem hopelessly bleak. But, although the task can appear
insurmountable, there are groups working to combat the corporate divvy-up of UK
public healthcare. And they require public support now more than ever before.

This judicial review action, for instance, has already
prevented swathes of ACOs from being rubber-stamped until the case and
consultation reaches a conclusion – they had initially been scheduled to come
into effect this April.

The case can only go so far, though, due to its
necessarily limited remit. Beyond other standalone legal
battles like it, what has so far been stripped away can only be rehabilitated
and restored by an Act of Parliament – which is why it is essential to support
the Private Members’ Bill on 11th July to reclaim and begin to
re-instate the NHS.

About the author

Tommy Greene is a young
freelance journalist and writer currently living in Belfast. You can find him
on Twitter here.

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